DOCSLIB.ORG

Upper Limb Pyrophosphate Tenosynovitis Outside the Carpal Tunnel

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Upper Limb Pyrophosphate Tenosynovitis Outside the Carpal Tunnel Ann Rheum Dis: first published as 10.1136/ard.48.8.689 on 1 August 1989. Downloaded from Annals of the Rheumatic Diseases 1989; 48: 689-691 Upper limb pyrophosphate tenosynovitis outside the carpal tunnel J C GERSTER AND R LAGIER From the Rheumatology and Rehabilitation Centre, University Hospital, CHUV, Lausanne and the Department of Pathology (Osteoarticular Unit), Medical School, Geneva, Switzerland SUMMARY Three cases of calcium pyrophosphate dihydrate (CPPD) crystal deposits in tendon sheaths outside the carpal tunnel are reported. Crystals were shown by x ray diffraction analysis in one case and by compensated light microscopy in the other two. Surgical excision of the tendon synovial sheath had to be done in two cases (one case with CPPD crystal deposits). Extra-articular deposition of calcium pyrophosphate swollen and tender and the shoulders were limited dihydrate (CPPD) crystals has been described in and tender. Radiographs showed chondrocalcinosis rare cases, especially in the ligamentum flavuml4 of both wrists, both knees, and a destructive and in various kinds of tendons: triceps,5 flexor arthropathy of the left shoulder. Degenerative digitorum,3 and Achilles tendon.6 7 It has also been reported in bursitis,5 in subcutaneous tissue,"O and copyright. even in the dura mater.11 Presumed similar deposits have been radiologically reported in patients other- wise known for CPPD crystal deposition disease -for example, in transverse ligament of the second cervical vertebra12 and in flexor digitorum.13 The association of carpal tunnel syndrome with articular chondrocalcinosis has been classically reported'4v7; http://ard.bmj.com/ deposits of CPPD crystals have been found in the volar carpal ligament as well as in the tendon sheaths. "" l9 We report the finding of CPPD crystals in the synovial fluid from tendon sheaths outside the carpal tunnel. Case report on September 29, 2021 by guest. Protected CASE 1 A 72 year old woman had been operated on for a bilateral carpal tunnel syndrome 10 years ago. She had been suffering from pain in the left knee for about five years and from pain in both shoulders for three years. In addition, she had had painful swelling of the ventral part of the fifth left finger for about 10 months. Clinically, the tendon sheath was diffusely swollen and tender and motion of the finger was restricted (Fig. 1). The left knee was sZ i.^, . ^ Accepted for publication 9 January 1989. Correspondence to Dr J C Gerster, Rheumatology and Rehabilita- tion Centre, University Hospital, CHUV, CH-1011 Lausanne, Fig. 1 Case 1. Diffuse swelling ofthe tendon sheath ofthe Switzerland. fifth finger. 39 Ann Rheum Dis: first published as 10.1136/ard.48.8.689 on 1 August 1989. Downloaded from 690 Gerster, Lagier changes of the first carpometacarpal joints were also examinatiuon was performed on stained (haemat- found in the left hand. oxylin and eosin and von Kossa stain) and unstained Examination of the synovial fluid of the left knee slides, which were examined by polarised light. It showed 0*2x109 leucocytes/l with rare intracellular showed a non-specific synovial hyperplasia with scar positive birefringent crystals. Red S alizarin staining remodelling but without CPPD crystal deposits. was negative. Synovial fluid was removed from the Examination of some fragments by transmitted tenosynovial cavity of the finger (25 January 1988); electron microscopy and by x ray electron diffraction it was gelatinous and contained rare white deposits did not show CPPD crystals. 2-3 mm in diameter. x Ray powder diffraction analyses of this material showed CPPD crystals in triclinic form. Tenosynovitis recurred, and a syno- Discussion vectomy was performed in April 1988. Histological examination was performed on slides stained by The common feature of these three cases is a hand haematoxylin and eosin and by von Kossa stain for tenosynovitis whose exudated synovial fluid con- calcium phosphate. It showed a non-specific scar tained CPPD crystals which were disclosed by x ray remodelling of the synovium with gelatinous deposits diffraction in one case and by the presence of rod- and only an isolated small area of CPPD crystal like positive birefringent crystals in the others. In deposits. Recovery was uneventful. only one case were CPPD crystal deposits found in the neighbouring synovium and this patient CASE 2 had presented with radiological signs of chondro- In February 1988 a 77 year old man developed calcinosis in both knee and wrist joints. In the other nodular thickening of the palmar surface of his left two cases chondrocalcinosis was shown by x ray wrist. He was also suffering from pain in the first examination in only one of them. carpometacarpal joints bilaterally and from chronic These cases show that CPPD crystal deposits in pain in the left knee with some acute typical attacks the hand in extra-articular locations induce not only of pseudogout. Examination of the left wrist showed a carpal tunnel syndrome but also tenosynovitiscopyright. a distended synovial sheath of the flexor carpi even in the absence of radiological signs of chondro- ulnaris 0-8 cm in diameter. calcinosis elsewhere in the joints. Synovial fluid There were no signs of carpal tunnel syndrome. examination seems to be more simple and sensitive x Ray examination showed chondrocalcinosis of than a synovial biopsy, particularly as histological both knees but no chondrocalcinosis of the wrists. changes are not equally spread. It is uncertain Aspiration of the synovial fluid from the teno- whether the primary CPPD crystal deposits involve the tenosynovial membrane or the tendon itself. synovial cavity produced a clear fluid containing http://ard.bmj.com/ 1*3 x 109 leucocytes/l (98% mononuclear) with plenty of intracellular positive rod-like birefringent crystals. The authors thank Professor C A Baud, Institute of Morphology, University Hospital, Geneva, for x ray diffractions and Dr C A topical corticosteroid agent was injected with a Simonetta, Permanence Chirurgicale de Longeraie, Lausanne, for good result. clinical data. CASE 3 References A 53 year old woman had suffered from tenosynovitis 1 Bywaters E G L, Hamilton EB D, Williams R. The spine in of the extensor tendon sheaths of the fingers in 1965. idiopathic haemochromatosis. Ann Rheum Dis 1971; 30:453-65. on September 29, 2021 by guest. Protected A was but there was 2 Ellman M H, Vazquez T, Ferguson L, Mandel N. Calcium tenosynovectomy performed, pyrophosphate deposition in ligamentum flavum. Arthritis no histological examination. In 1986 the symptoms Rheum 1978; 21: 611-3. occurred again. 3 Lagier R. L'approche anatomo-pathologique du concept de Clinical examination was normal except for a chondrocalcinose articulaire. Rhumatologie 1981; 33: 421-37. swollen tendon sheath of the extensor tendons of the 4 Nagashima C, Takahama M, Shibata T, et al. Calcium pyrophosphate dihydrate deposits in the cervical ligamenta right wrist and for a tendemess of the first carpo- flava causing myeloradiculopathy. J Neurosurg 1984; 60: 69-80. metacarpal joint. Examination of 0*5 ml of synovial 5 Gerster J C, Lagier R, Boivin G. Olecranon bursitis related to fluid from the tendon synovial cavity showed 0*9 x 109 calcium pyrophosphate dihydrate crystal deposition disease. leucocytes/l (98% mononuclear) with intracellular Clinical and pathologic study. Arthritis Rheum 1982; 25: 989-96. 6 Gerster J C, Baud C A, Lagier R, Boussina I, Fallet G H. and extracellular positive rod-like birefringent Tendon calcifications in chondrocalcinosis. Arthritis Rheum crystals. 1977; 20: 717-22. An x ray examination of the hand and knees failed 7 Gerster J C, Lagier R, Boivin G. Achilles tendinitis associated to show of chondrocalcinosis. A with chondrocalcinosis. J Rheumatol 1980; 7: 82-9. signs tenosyno- 8 Leisen J C, Austad E D, Bluhm G B, Sigler J W. The tophus in vectomy was performed in November 1986. The calcium pyrophosphate deposition disease. JAMA 1980; 244: synovial fluid contained crystals. Histological 1711-2. Ann Rheum Dis: first published as 10.1136/ard.48.8.689 on 1 August 1989. Downloaded from Upper limb pyrophosphate tenosynovitis 691 9 Rothschild B M, Round M J. Subcutaneous crystal deposition 15 Rubinstein H M, Shah D M. Pseudogout. Semin Arthritis in pseudogout. JAMA 1980; 244: 2079-80. Rheum 1973; 2: 259-80. 10 Schumacher H R Jr, Bonner H, Thompson J J, Kester W L, 16 Spiegel P G, Ginsberg M, Skosey J L, Kwong P. Acute carpal Benner J J. Tumor-like soft tissue swelling of the distal phalanx tunnel syndrome secondary to pseudogout: case report. Clin due to calcium pyrophosphate dihydrate crystal deposition. Orthop 1976; 120: 185-7. Arthritis Rheum 1984; 27: 1428-32. 17 Goodwin D R A, Arbel R. Pseudogout of the wrist presenting 11 Grahame R, Sutor D J, Mitchener M B. Crystal deposition in as acute median nerve compression. J Hand Surg [Br] 1985; 10: hyperparathyroidism. Ann Rheum Dis 1971; 30: 597-604. 261-2. 12 Dirheimer Y, Bensimon C, Christmann D, Wackenheim C. Syndesmo-odontoid joint and calcium pyrophosphate dihydrate 18 Gerster J C, Lagier R, Boivin G, Schneider C. Carpal tunnel deposition disease. Neuroradiology 1983; 25: 319-21. syndrome in chondrocalcinosis of the wrist. Clinical and 13 Bywaters E G L, Dixon A St J, Scott J. Joint lesion of histologic study. Arthritis Rheum 1980; 23: 924-31. hyperparathyroidism. Ann Rheum Dis 1963; 22: 171-87. 19 Lagier R, Boivin G, Gerster J C. Carpal tunnel syndrome 14 Weinstein J D, Dick H M, Grantham S A. Pseudogout, hyper- associated with mixed calcium pyrophosphate dihydrate and parathyroidism, and carpal tunnel syndrome: a case report. apatite crystal deposition in tendon synovial sheath. Arthritis J Bone Joint Surg [Am], 1968; 50: 1669-74. Rheum 1984; 27: 1190-5. copyright. http://ard.bmj.com/ on September 29, 2021 by guest. Protected.
Load more

Recommended publications
  • Juvenile Spondyloarthropathies: Inflammation in Disguise
    PP.qxd:06/15-2 Ped Perspectives 7/25/08 10:49 AM Page 2 APEDIATRIC Volume 17, Number 2 2008 Juvenile Spondyloarthropathieserspective Inflammation in DisguiseP by Evren Akin, M.D. The spondyloarthropathies are a group of inflammatory conditions that involve the spine (sacroiliitis and spondylitis), joints (asymmetric peripheral Case Study arthropathy) and tendons (enthesopathy). The clinical subsets of spondyloarthropathies constitute a wide spectrum, including: • Ankylosing spondylitis What does spondyloarthropathy • Psoriatic arthritis look like in a child? • Reactive arthritis • Inflammatory bowel disease associated with arthritis A 12-year-old boy is actively involved in sports. • Undifferentiated sacroiliitis When his right toe starts to hurt, overuse injury is Depending on the subtype, extra-articular manifestations might involve the eyes, thought to be the cause. The right toe eventually skin, lungs, gastrointestinal tract and heart. The most commonly accepted swells up, and he is referred to a rheumatologist to classification criteria for spondyloarthropathies are from the European evaluate for possible gout. Over the next few Spondyloarthropathy Study Group (ESSG). See Table 1. weeks, his right knee begins hurting as well. At the rheumatologist’s office, arthritis of the right second The juvenile spondyloarthropathies — which are the focus of this article — toe and the right knee is noted. Family history is might be defined as any spondyloarthropathy subtype that is diagnosed before remarkable for back stiffness in the father, which is age 17. It should be noted, however, that adult and juvenile spondyloar- reported as “due to sports participation.” thropathies exist on a continuum. In other words, many children diagnosed with a type of juvenile spondyloarthropathy will eventually fulfill criteria for Antinuclear antibody (ANA) and rheumatoid factor adult spondyloarthropathy.
    [Show full text]
  • Bursae Around the Knee Joints Priyank S Chatra Department of Radiology, Yenepoya Medical College, Mangalore, Karnataka, India
    MUSCULOSKELETAL RADIOLOGY Bursae around the knee joints Priyank S Chatra Department of Radiology, Yenepoya Medical College, Mangalore, Karnataka, India Correspondence: Dr. Priyank S. Chatra, Department of Radiology, Yenepoya Medical College, Deralakatte, Mangalore – 575 018, Karnataka, India. E-mail: [email protected] Abstract A bursa is a fluid-filled structure that is present between the skin and tendon or tendon and bone. The main function of a bursa is to reduce friction between adjacent moving structures. Bursae around the knee can be classified as those around the patella and those that occur elsewhere. In this pictorial essay we describe the most commonly encountered lesions and their MRI appearance. Key words: Iliotibial bursa; infrapatellar bursa; pes anserine bursa Introduction and the gastrocnemius-semimembranosus bursa. On MRI imaging, bursitis appears as an oblong fluid collection in A bursa is a fluid-filled structure that is present between its expected anatomical location. the skin and tendon or tendon and bone. The main function of a bursa is to reduce friction between adjacent Prepatellar Bursitis moving structures. Typically, bursae are located around large joints such as the shoulder, knee, hip, and elbow.[1] The prepatellar bursa is located between the patella and the Inflammation of this fluid-filled structure is called bursitis. overlying subcutaneous tissue. Chronic trauma in the form Trauma, infection, overuse, and hemorrhage are some of prolonged or repeated kneeling leads to inflammation of the common
    [Show full text]
  • 'Dialysis Related Arthropathy': a Survey of 95 Patients Receiving Chronic Haemodialysis with Special Reference to 132 Microglobulin Related Amyloidosis
    Ann Rheum Dis: first published as 10.1136/ard.48.5.409 on 1 May 1989. Downloaded from Annals of the Rheumatic Diseases, 1989; 48, 409-420 'Dialysis related arthropathy': a survey of 95 patients receiving chronic haemodialysis with special reference to 132 microglobulin related amyloidosis N P HURST,' R VAN DEN BERG,' A DISNEY,2 M ALCOCK,3 L ALBERTYN,3 M GREEN,' AND V PASCOE4 From the 'Rheumatology Unit, the 2Renal Unit, the 3Department of Radiology, and the 4Department of Pathology, The Queen Elizabeth Hospital, Woodville, South Australia SUMMARY Ninety five patients receiving chronic haemodialysis (CHD) were surveyed to determine the prevalence of rheumatic disease and, where possible, its aetiology. At least three distinct rheumatic syndromes were identified-a group of patients with a syndrome consisting of large and medium joint synovial swelling, restricted hips and shoulders, tenosynovitis, carpal tunnel syndrome, and bone cysts due to deposition of 132 microglobulin related amyloid (AMP2m); a second group with erosive azotaemic osteoarthropathy; and a third group with age related degenerative disease of small, large, and axial joints. The data presented suggest that in patients receiving CHD (a) the prevalence of AM2i2m deposition and the associated syndrome increases with duration of dialysis, but in patients who have been dialysed for more than 10 years the risk of developing AM2n2m is related to age; (b) AM2i2m deposition in subchondral cysts, but not synovium, causes joint destruction; also, AMp2m may be more prone to deposition in synovium of joints already damaged by other processes; (c) in the absence of synovial iron deposition synovial AM2n2m is not associated with an inflammatory infiltrate; (d) hyperparathyroidism and perhaps other factors such as synovial iron deposition are probably more important than AMgi2m as causes http://ard.bmj.com/ of peripheral joint degeneration and destructive spondyloarthropathy in patients receiving CHD.
    [Show full text]
  • Acute Hand Infections
    CURRENT CONCEPTS Acute Hand Infections Meredith Osterman, MD, Reid Draeger, MD, Peter Stern, MD CME INFORMATION AND DISCLOSURES The Review Section of JHS will contain at least 3 clinically relevant articles selected by the Provider Information can be found at http://www.assh.org/Pages/ContactUs.aspx. editor to be offered for CME in each issue. For CME credit, the participant must read the Technical Requirements for the Online Examination can be found at http://jhandsurg. articles in print or online and correctly answer all related questions through an online org/cme/home. examination. The questions on the test are designed to make the reader think and will occasionally require the reader to go back and scrutinize the article for details. Privacy Policy can be found at http://www.assh.org/pages/ASSHPrivacyPolicy.aspx. The JHS CME Activity fee of $30.00 includes the exam questions/answers only and does not ASSH Disclosure Policy: As a provider accredited by the ACCME, the ASSH must ensure fi include access to the JHS articles referenced. balance, independence, objectivity, and scienti c rigor in all its activities. Disclosures for this Article Statement of Need: This CME activity was developed by the JHS review section editors Editors and review article authors as a convenient education tool to help increase or affirm fl reader’s knowledge. The overall goal of the activity is for participants to evaluate the Ghazi M. Rayan, MD, has no relevant con icts of interest to disclose. appropriateness of clinical data and apply it to their practice and the provision of patient Authors care.
    [Show full text]
  • Rotator Cuff and Subacromial Impingement Syndrome: Anatomy, Etiology, Screening, and Treatment
    Rotator Cuff and Subacromial Impingement Syndrome: Anatomy, Etiology, Screening, and Treatment The glenohumeral joint is the most mobile joint in the human body, but this same characteristic also makes it the least stable joint.1-3 The rotator cuff is a group of muscles that are important in supporting the glenohumeral joint, essential in almost every type of shoulder movement.4 These muscles maintain dynamic joint stability which not only avoids mechanical obstruction but also increases the functional range of motion at the joint.1,2 However, dysfunction of these stabilizers often leads to a complex pattern of degeneration, rotator cuff tear arthropathy that often involves subacromial impingement.2,22 Rotator cuff tear arthropathy is strikingly prevalent and is the most common cause of shoulder pain and dysfunction.3,4 It appears to be age-dependent, affecting 9.7% of patients aged 20 years and younger and increasing to 62% of patients of 80 years and older ( P < .001); odds ratio, 15; 95% CI, 9.6-24; P < .001.4 Etiology for rotator cuff pathology varies but rotator cuff tears and tendinopathy are most common in athletes and the elderly.12 It can be the result of a traumatic event or activity-based deterioration such as from excessive use of arms overhead, but some argue that deterioration of these stabilizers is part of the natural aging process given the trend of increased deterioration even in individuals who do not regularly perform overhead activities.2,4 The factors affecting the rotator cuff and subsequent treatment are wide-ranging. The major objectives of this exposition are to describe rotator cuff anatomy, biomechanics, and subacromial impingement; expound upon diagnosis and assessment; and discuss surgical and conservative interventions.
    [Show full text]
  • Rotator Cuff Tear Arthropathy: Pathophysiology, Diagnosis And
    yst ar S em ul : C c u s r u r e M n t & R Orthopedic & Muscular System: c e Aydin, et al., Orthopedic Muscul Syst 2014, 3:2 i s d e e a p ISSN: 2161-0533r o c DOI: 10.4172/2161-0533-3-1000159 h h t r O Current Research Review Article Open Access Rotator Cuff Tear Arthropathy: Pathophysiology, Diagnosis and Treatment Nuri Aydin*, Okan Tok and Bariş Görgün Istanbul University Cerrahpaşa, School of Medicine, Istanbul, Turkey *Corresponding author: Nuri Aydin, Istanbul University Cerrahpaşa, School of Medicine, Orthopaedics and Traumatology, Istanbul, Turkey, Tel: +905325986232; E- mail: [email protected] Rec Date: Jan 25, 2014, Acc Date: Mar 22, 2014, Pub Date: Mar 28, 2014 Copyright: © 2014 Aydin N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract The term rotator cuff tear arthropathy is a broad spectrum pathology but it involves common characteristic features as rotator cuff tear, leading to glenohumeral joint arthritis and superior migration of the humeral head. Although there are several factors described causing rotator cuff tear arthropathy, the exact mechanism is still unknown because the rotator cuff tear arthropathy develops in only a group of patients with chronic rotator cuff tear. The aim of this article is to review pathophysiology of rotator cuff tear arthropathy, to explain the diagnostic features and to discuss the management of the disease. Keywords: Arthropathy; Glenohumeral joint; Articular fluid Rotator cuff tear not only plays a role at the beginning of the disease, but also a developed rotator cuff tear is a result of the inflammatory Introduction process.
    [Show full text]
  • CPT® Procedural Coding 110 L with Areportoftheprocedure
    20610-20611 2017 Illustrated Coding and Billing Expert for Orthopedics Lower 20610-20611 ICD-9-CM Diagnostic Codes M16.7 Other unilateral secondary 711.05 Pyogenic arthritis involving pelvic osteoarthritis of hip 20610 Arthrocentesis, aspiration and/or region and thigh M17.0 Bilateral primary osteoarthritis of injection, major joint or bursa (eg, 711.06 Pyogenic arthritis involving lower leg knee shoulder, hip, knee, subacromial 713.5 Arthropathy associated with ⇄ M17.11 Unilateral primary osteoarthritis, right bursa); without ultrasound guidance neurological disorders knee 20611 Arthrocentesis, aspiration and/or 714.0 Rheumatoid arthritis ⇄ M17.12 Unilateral primary osteoarthritis, left knee injection, major joint or bursa (eg, 715.15 Osteoarthrosis, localized, primary, pelvic region and thigh M17.2 Bilateral post-traumatic osteoarthritis shoulder, hip, knee, subacromial 715.16 Osteoarthrosis, localized, primary, of knee bursa); with ultrasound guidance, with lower leg M17.5 Other unilateral secondary permanent recording and reporting 715.25 Osteoarthrosis, localized, secondary, osteoarthritis of knee (Do not report 20610, 20611 in pelvic region and thigh ⇄ M1A.051 Idiopathic chronic gout, right hip conjunction with 27370, 76942) 715.26 Osteoarthrosis, localized, secondary, ⇄ M1A.062 Idiopathic chronic gout, left knee (If fluoroscopic, CT, or MRI guidance is lower leg ⇄ M25.052 Hemarthrosis, left hip ⇄ M25.061 Hemarthrosis, right knee performed, see 77002, 77012, 77021) 715.35 Osteoarthrosis, localized, not specified whether primary
    [Show full text]
  • Current Trends in Tendinopathy Management
    Best Practice & Research Clinical Rheumatology 33 (2019) 122e140 Contents lists available at ScienceDirect Best Practice & Research Clinical Rheumatology journal homepage: www.elsevierhealth.com/berh 8 Current trends in tendinopathy management * Tanusha B. Cardoso a, , Tania Pizzari b, Rita Kinsella b, Danielle Hope c, Jill L. Cook b a The Alphington Sports Medicine Clinic, 339 Heidelberg Road, Northcote, Victoria, 3070, Australia b La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury Drive, Bundoora, Victoria, 3083, Australia c MP Sports Physicians, Frankston Clinic, Suite 1, 20 Clarendon Street, Frankston, Victoria, 3199, Australia abstract Keywords: Tendinopathy Tendinopathy (pain and dysfunction in a tendon) is a prevalent Management clinical musculoskeletal presentation across the age spectrum, Rehabilitation mostly in active and sporting people. Excess load above the ten- Achilles tendinopathy don's usual capacity is the primary cause of clinical presentation. Rotator cuff tendinopathy The propensity towards chronicity and the extended times for recovery and optimal function and the challenge of managing tendinopathy in a sporting competition season make this a difficult condition to treat. Tendinopathy is a heterogeneous condition in terms of its pathology and clinical presentation. Despite ongoing research, there is no consensus on tendon pathoetiology and the complex relationship between tendon pathology, pain and func- tion is incompletely understood. The diagnosis of tendinopathy is primarily clinical, with imaging only useful in special circum- stances. There has been a surge of tendinopathy treatments, most of which are poorly supported and warrant further exploration. The evidence supports a slowly progressive loading program, rather than complete rest, with other treatment modalities used as adjuncts mainly targeted at achieving pain relief.
    [Show full text]
  • Pigmented Villonodular Synovitis in Pediatric Population: Review of Literature and a Case Report Mohsen Karami*, Mehryar Soleimani and Reza Shiari
    Karami et al. Pediatric Rheumatology (2018) 16:6 DOI 10.1186/s12969-018-0222-4 CASEREPORT Open Access Pigmented villonodular synovitis in pediatric population: review of literature and a case report Mohsen Karami*, Mehryar Soleimani and Reza Shiari Abstract Background: Pigmented villonodular synovitis (PVNS) is a rare proliferative process in children that mostly affects the knee joint. Case Presentation: The study follows the case of a 3-year-old boy presenting recurrent patellar dislocation and PVNS. Due to symptoms such as chronic arthritis, he had been taking prednisolone and methotrexate for 6 months before receiving a definitive diagnosis. After a period of showing no improvements from his treatment, he was referred to our center and was diagnosed with local PVNS using magnetic resonance imaging (MRI). The patient was treated for his patellar dislocation by way of open synovectomy, lateral retinacular release, and a proximal realignment procedure, with no recurrence after a 24-month follow-up. Conclusion: PVNS may appear with symptoms resembling juvenile idiopathic arthritis, thus the disease should be considered in differential diagnosis of any inflammatory arthritis in children. PVNS may also cause mechanical symptoms such as patellar dislocation. In addition to synovectomy, a realignment procedure can be a useful method of treatment. Keywords: Juvenile idiopathic arthritis, Patellar dislocation, Pigmented villonodular synovitis Background aberrations that cause hemorrhagic tendencies, as well as Pigmented villonodular synovitis (PVNS) is a rare prolif- genetic factors, have been proposed as potential causes erative process that affects the synovial joint, tendon [2, 3]. Trauma and rheumatoid arthritis association have sheaths, and bursa membranes [1]. The estimated inci- also been considered [14, 15, 33].
    [Show full text]
  • Calcified Tendinitis: a Review
    Ann Rheum Dis: first published as 10.1136/ard.42.Suppl_1.49 on 1 January 1983. Downloaded from Ann Rheum Dis (1983), 42, Supplement p 49 Calcified tendinitis: a review G. FAURE,' G. DACULSI2 From the 'Clinique Rhumatologique et Laboratoire d'immunologie, Faculte A de Medecin, Universite de Nancy I, 54500 Vandoeuvre les Nancy, France and 2U225 INSERM, Faculte de Chirurgie Dentaire, Place Alexis Ricordeau, 44042 Nantes, France Introduction Calcified tendinitis in clinical practice Calcified tendinitis is a common CLINICAL FEATURES disorder. Many names have been used According to Welfling calcific to describe it: some of them, such as periarthritis is responsible for 7% of 'calcific periarthritis', emphasise the painful shoulder syndromes,' which extra-articular site of the deposit; have various presentations. others, such as 'periarticular apatite (1) Chronic symptoms-more or deposition', mention the nature of the less severe pain; tenderness leading to compound found in the calcification; various degrees of incapacitation. and more recent ones, such as These symptoms induce the demand 'calcifying tendinitis',-'3 emphasise the. for radiographs, which reveal the Fig. 1 Calcific periarthritis ofthe active process that might explain the presence of deposits. shoulder. Calcification is obvious; it deposition. Differentiated from (2) Acute inflammatory crisis with has already migrated from copyright. arthritis at the end of the nineteenth severe pain, tenderness, and local supraspinatus region to bursa area. century, this syndrome has only oedematous inflammation sometimes recently been related to the presence leading to restricted active an*d passive of apatite in tendon sheaths.4'5 It can motion. Fever and malaise may be affect almost any tendon at its observed.
    [Show full text]
  • Musculoskeletal Ultrasound in the Evaluation of Polymyalgia Rheumatica
    Review Med Ultrason 2015, Vol. 17, no. 3, 361-366 DOI: 10.11152/mu.2013.2066.173.aig Musculoskeletal ultrasound in the evaluation of Polymyalgia Rheumatica Iolanda Maria Rutigliano, Chiara Scirocco, Fulvia Ceccarelli, Annacarla Finucci, Annamaria Iagnocco Rheumatology Unit, Sapienza Università di Roma, Rome, Italy Abstract Polymyalgia rheumatica (PMR) is a relatively frequent disease affecting individuals older than 50 years and is character- ized by inflammatory involvement of the shoulder and hip girdles and the neck. Clinical manifestations are represented by pain and morning stiffness in this regions. An extensive and comprehensive assessment of the inflammatory status is crucial in PMR patients, including imaging evaluation. This narrative review reports the current available data in the literature about the role of musculoskeletal ultrasound in PMR. Keywords: polymyalgia rheumatica, ultrasound, bursitis, tenosynovitis Introduction PMR is characterized by pain and morning stiffness, longer than 45 min, involving the neck and the shoulder Polymyalgia rheumatica (PMR) is an inflammatory and hip girdles. Stiffness and pain are usually bilateral, rheumatic condition that typically affects individuals old- worsen in the morning and improve with activity. Fa- er than 50 years, with incidence increasing with age. An tigue, malaise, anorexia, weight loss and fever are also Italian epidemiologic study reported an annual incidence common and are considered “constitutional symptoms”. rate of PMR over the period 1980–1988 of 12.7/100,000 An association between PMR and giant-cell arteritis [1-2]. The etiology of PMR remains unknown, although (GCA) has been described and PMR has been identified currently the role of both genetic and environmental fac- in 40-60% of patients affected by GCA; on the contra- tors, such as infections, has been hypothesized.
    [Show full text]
  • Trauma and Reiter's Syndrome: Development of 'Reactive Arthropathy' in Two Patients Following Musculoskeletal Injury
    Ann Rheum Dis: first published as 10.1136/ard.43.6.829 on 1 December 1984. Downloaded from Annals of the Rheumatic Diseases, 1984, 43, 829-832 Trauma and Reiter's syndrome: development of 'reactive arthropathy' in two patients following musculoskeletal injury JEFFREY J. WISNIESKI From the Medical Service, Rheumatology Section, Cleveland Veterans Administration Medical Center, and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. SUMMARY Two patients are reported who developed arthropathies with some features of Reiter's syndrome shortly after physical injury. Both were HLA-B27 positive. No other precipitating factors were identified, and the possibility that trauma may have precipitated a reactive arth- ropathy is discussed. Key words: endogenous antigen (immunogen), genetic predisposition, collagen. copyright. Concepts of Reiter's syndrome (RS) have changed swelling, pain, and heat; internal mechanical dramatically in the past decade. Notable develop- derangement was suspected. Five months after the ments include: (1) recognition that clinical activity trauma arthroscopy revealed hyperaemic and thick- may be acute/self-limited, acute/recurrent, or ened synovium but no structural abnormality. Syno- chronic'-5; (2) recognition that disease mani- vial biopsy showed chronic synovitis with marked festations vary from 'incomplete' RS to multisystem lymphocyte and plasma cell infiltration. involvement'-3; (3) development of concepts of Seven months after the injury the knee continued genetic predisposition and linkage4 5; and (4) charac- to be warm and painful, with thickened synovium and http://ard.bmj.com/ terisation of RS as reactive arthritis developing in a large effusion. No other joints were involved. Con- genetically predisposed individuals.45 In most junctivitis of the left eye was noted.
    [Show full text]